Rekurentne infekcije uzrokovane bakterijom Clostridioides difficile

master's thesis

• Title (english): Recurrent Clostridioides difficile infections
• Author: Valentina Kunić
• Mentor: Mirjana Balen Topić (mentor)
• Committee member: Adriana Vince (predsjednik povjerenstva)
• Committee member: Goran Tešović (član povjerenstva)
• Committee member: Mirjana Balen Topić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Infectious Diseases); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology

Abstract

Clostridioides difficile je ubikvitarna, anaerobna bakterija koja nepovoljne uvjete preživljava formiranjem spora. Zabilježena je kao najčešći uzročnik bolničkih infekcija te predstavlja značajan problem za zdravstveni sustav mnogih zemalja. Klinička slika koju izaziva može varirati od blagog, samolimitirajućeg proljeva do fulminantnog kolitisa. U posljednje vrijeme javljaju se epidemije diljem svijeta uzrokovane hipervirulentnim sojevima C. difficile, koji osim što rezultiraju povećanim morbiditetom i mortalitetom, dovode do povećane učestalosti rekurentnih epizoda. Rekurentne infekcije se javljaju u oko 25% pacijenata nakon preboljene inicijalne epizode, a učestalost im se povećava svakom novom rekurentnom epizodom. Postoje mnogobrojni čimbenici rizika povezani s nastankom rekurentnih epizoda, od kojih su ponovna upotreba antibiotika, visoka životna dob te zaraza hipervirulentnim sojevima među najznačajnijima. Pravodobna dijagnoza bolesti je nužna za odabir adekvatne terapije. Pritom odabir terapijskog protokola ovisi o tome radi li se o inicijalnoj ili rekurentnoj infekciji te o broju rekurentne epizode. U terapiji se najveći uspjeh postiže peroralnom primjenom vankomicina i fidaksomicina, a u terapiji višestrukih rekurentnih epizoda se preporučuje transplantacija fekalne mikrobiote. Postoje obećavajuće terapijske opcije, poput primjene monoklonalnog protutijela bezlotoksumaba, u smanjenju učestalosti rekurentnih epizoda, što međutim iziskuje daljnja istraživanja. Budući da rekurentne infekcije predstavljaju izrazito opterećenje za zdravstveni sustav pojedine zemlje, potrebno je prepoznati i umanjiti učinak rizičnih čimbenika te primijeniti adekvatne preventivne mjere kako bi se negativan učinak ovih infekcija smanjio na minimum.

Abstract (english)

Clostridioides difficile is ubiquitous, anaerobic bacteria that survives unfavorable conditions by forming spores. It is the most common hospital pathogen thus representing a major problem for healthcare systems in many countries. Clinical manifestations can range in severity from minimal, self-limited diarrhea to severe fulminant colitis. Lately, there have been several epidemic outbreaks across the world caused by hypervirulent C. difficile strains that not only increase morbidity and
mortality rates, but also lead to a higher recurrence rate. Recurrent infections occur in approximately 25% patients following initial episode and its rates increase with every new recurrent episode. Many risk factors are associated with recurrence, some of the most important being repeated antibiotic use, increased age of the patient and infection with hypervirulent strains. A timely diagnosis is required in order to choose the right therapy. At the same time, choosing the therapeutic protocol depends on the infection being the initial episode or (and which number of) recurrent episode. Oral vancomycin and fidaxomicin have shown the greatest success in the treatment of recurrent C. difficile infections, while fecal microbiota transplantation remains recommended therapy option for multiple recurrences. There are many promising therapeutic options regarding reduction of recurrence rates, with monoclonal antibody bezlotoxumab being one of them. However further studies are being required. Since recurrent infections represent extreme healthcare burden for the country, it is important to recognize and reduce the impact of recurrence risk factors, as well as apply adequate preventive measures, in order to reduce the negative effect of these infections to the minimum.

• Keywords: Clostridoides difficile; rekurentna Clostridioides difficile infekcija; liječenje; prevencija
• Keywords (english): Clostridioides difficile; recurrent Clostridioides difficile infection; treatment; prevention
• Language: croatian
• URN:NBN: urn:nbn:hr:105:585565
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-19 07:46:28